Life In The Country Can Be Dangerous

The idyllic vision of life in the country is a dream for many who imagine rolling hills, beautiful streams and a leisurely pace. But West Virginia University researchers question that scenic tableau in a study showing that injuries requiring hospitalization occur at much higher rates in rural areas.

"The perception is that life in rural areas is peaceful, tranquil, serene," said Jeffrey H. Coben, M.D., a professor in the WVU Injury Control Research Center. "If you just look at violence - person against person - the rates are higher in urban areas. But for virtually every other cause of trauma, the risks are substantially greater in rural areas."

The study, published in the January issue of the American Journal of Preventive Medicine, is the first of its kind, according to Coben. Previous studies have examined injuries related to a single activity or in a single state. Other studies have analyzed deaths, also shown to be higher in rural areas. The WVU study looked at all reported injuries of people who were admitted to hospitals for treatment in the United States in 2004, the last year for which data were available.

Large urban counties carried the highest hospitalization rates for assaults. But rural counties led in hospitalizations for motor-vehicle crashes, falls and poisonings. Self-inflicted injuries were also higher in rural counties, with poisons, knives and guns the instruments of choice.

"What we are seeing across-the-board is, in both fatal and nonfatal cases, people who live in rural areas suffer more trauma," Coben said. Even though death rates from injury are already known to be higher in rural areas, studying nonfatal injury rates is important, Coben said. "By demonstrating that there's also a significantly higher injury rate in rural areas, we're showing an increased incidence of injury is the problem - not just access to care or the promptness of care."

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Some injuries are attributable to high-risk occupations such as mining, farming and logging.

Why are injuries from motor-vehicle crashes more prevalent in rural areas? Not only are people more likely to drive longer distances for recreation and to work, but also seatbelt usage is lower. Highway improvements such as barriers or dividers between opposing lanes are less likely to be in place, and roads that wind through mountainous areas are more likely to be treacherous.

Previous studies have shown that people who live in rural areas are more likely to take part in risky behaviors such as recreational drug use, drunken driving or failing to use seatbelts. Plus a culture of self-reliance may cause people to undertake household fix-up chores that are inherently dangerous, such as roof repairs.

"All of this contributes to a high rate of serious trauma," Coben said.

The researchers found the average hospital bill per injury was $27,000 - a sum that did not include follow-up rehabilitative care or the costs of long-term care that a spinal-cord injury, for instance, might require. Half of the patients hospitalized with injuries are covered by public sources of insurance such as Medicare or Medicaid, so these costs fall upon the public, Coben said.

States with large rural populations might want to consider placing even greater emphasis on enforcing safety policies and implementing safety programs such as making child car-seats, household smoke detectors and bicycle helmets available. Such injury-prevention programs have been found to be effective in urban populations, he said.

"Many of these increased risks are potentially preventable or modifiable. As states are balancing their budgets and trying to control healthcare costs, policymakers ought to be looking at how to prevent these injuries," Coben said. "Those states having a high percentage of people in rural communities might want to give a high priority to implementing policies and programs to prevent injuries."

The researchers used Agency for Healthcare Research and Quality data and U.S. Census population estimates to calculate the hospitalization rates. Researchers from the WVU Department of Emergency Medicine, the Department of Community Medicine and the Injury Control Research Center collaborated on the study.

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